Use of ultrasound guidance during cannulation of arteriovenous fistulas or arteriovenous grafts

Abstract

Individuals who require renal replacement therapy overwhelmingly choose outpatient hemodialysis. In December, 2013, 62.5% of these patients were using an arterial venous fistula (AVF) and 15% were using an arterial venous graft (AVG) for their hemodialysis access (National Institute of Diabetes and Digestive and Kidney Diseases, 2015). Appropriate cannulation techniques are an essential element in access preservation and prevention of access-related complications. Missed cannulations of AVFs result in damage to the fistula (Lee, Barker, & Allon, 2006). Ultrasound-guided cannulation has proven to be an effective technique for the placement of peripheral venous catheters (IVs) and for placement of central venous dialysis catheters (CVCs) (Brannam, Blaivas, Lyon, & Flake, 2004). The purposes of this scholarly project were to determine if ultrasound-guided cannulation of AVFs/AVGs decreased the number of missed cannulations, to determine staff and patient perceptions regarding cannulation, and to implement a quality-improvement project (QIP). The QIP consisted of creating an ultrasound-guided policy and procedure, training program, and competency evaluation at a hospital-based dialysis facility. Analysis of 53 electronic health records (EHRs) determined the number of missed cannulations in relation to the purchase and availability of a bedside ultrasound machine and implementation of the QIP. Likert scale surveys were distributed to staff and patients to determine familiarity with ultrasound-guided cannulation and perceptions concerning access cannulation. Results: Staff surveys demonstrated a need for policy and procedure, training, and competencies for ultrasound guided cannulation. Patient surveys demonstrated a need for more consistent ultrasound use and showed increased patient satisfaction with cannulation experience when ultrasound guidance was utilized. EHR data revealed a 53% reduction in the number of missed cannulations after the purchase and availability of a bedside ultrasound machine for ultrasound-guided cannulation. Conclusion: Implementation of an ultrasound-guided cannulation policy and procedure, training program, and competency helped guide staff with this cannulation technique. Further research is needed to determine if ultrasound guided cannulation should be classified as a best practice technique.